About Me

Wednesday, 1 May 2013

Quacks And Ducks In A Row

At the
doctor’s there is a small carefully placed notice to the effect that our
practice will no longer refer people direct to the consultants etc. at the
local hospital. Their recommendations
will now go to an assessment panel which will decide.

Who they
are; to whom they are accountable; where they are and what criteria they might
use is not known. At the same time a
friend of ours needed to call for medical assistance on an urgent matter.

His doctor
turned up and did not like at all what he saw. But there were problems. The doctor could not send him to hospital and
certainly not refer him to the appropriate speciality. The patient; or one of his family or friends
had to telephone 111.

There was a
snag since the man has another highly dangerous potentially terminal condition and it
is imperative for the hospital to be warned to be ready for him. Also, if affected he has but a short time to
get treatment which is over and beyond what his doctor could do. He needs paramedics and an ambulance.

But with
the 111 system this has now become impossible because of the procedures and the
fact that the person at the end of the phone is neither a clinician nor has
medical qualifications. The issue is
determined only on the immediate condition and without reference to any of the
predictable contingent risks.

If the
right boxes are not ticked as they are unlikely to be in his case then there is
no ambulance and his helpers must simply turn up at the hospital and hope for
the best. If he does just turn up at the
hospital then one slight error in the handling of the case means that within
minutes he is no longer a patient but one for the Coroner.

Although
his case may seem to be rare it is not all that rare. This is because whilst the condition is known
the system now deals only in terms of the single matter at any given time
regardless of any complications either known or potential. So when one condition creates significant
risks for any other this cannot be catered for.

What has
happened is that his doctor is no longer allowed to use his common sense or
professional judgement. There is no
flexibility of approach according to overall need. The hospital is no longer allowed to consider
complexities in complicated cases. An
ambulance may only be called if the prescribed boxes are ticked.

If they are
not then a fatality becomes simply a statistical margin of error in the new
system. The new system is almost tailor
made to generate fatalities in the most dangerous and high risk cases
especially those which require urgent and immediate action.

Meanwhile
the paper work will be kept in order; targets met and the increased activity
among the funeral directors will no doubt enhance economic growth.